title: Ultrafiltration versus intravenous diuretic therapy to treat acute heart failure: a systematic review.
abstract: BACKGROUND
  Patients with decompensated heart failure frequently present with volume overload, which is conventionally treated with diuretics. These drugs have been associated with several adverse effects, including increased mortality, leading some clinicians to propose ultrafiltration as a safe alternative to remove sodium and water.
  
  
  OBJECTIVE
  The objective of our study was to compare the safety and efficacy of ultrafiltration and conventional intravenous diuretic therapy for patients with acute heart failure and volume overload.
  
  
  METHODS
  We searched the following databases through November 2012: Cochrane Library (1993-), PubMed (1988-), OVID (1984-), EBSCO (1984-), CBM (1978-), VIP (1989-), and CNKI (1979-). In addition, we manually searched relevant references and review articles.
  
  
  METHODS
  Randomized controlled trials comparing the efficacy of ultrafiltration and intravenous diuretics in patients diagnosed with hypervolemic acute heart failure were included. Five trials were found to satisfy all the inclusion criteria.
  
  
  METHODS
  Two reviewers independently determined study eligibility, assessed methodological quality and extracted the data. We analyzed the data and pooled them, when appropriate, using Revman 5.0. We assessed the risk of bias in the included studies using guidelines in the Cochrane Handbook 5.0 for Systematic Reviews of Interventions, taking into account sequence generation, allocation concealment, blinding, incomplete outcome data, and selective outcome reporting.
  
  
  RESULTS
  Data from the initial phase of five trials involving 477 participants were included. Meta-analysis of the pooled data showed that ultrafiltration was significantly better than diuretic drugs based on 48-h weight loss (Z = 3.72; P < 0.001, weighted mean difference [WMD] = 1.25 kg, 95 % CI 0.59-1.91) and based on 48-h fluid removal (Z = 4.23; P < 0.001, WMD = 1.06 L, 95 % CI 0.57-1.56). Adverse events did not differ significantly between the ultrafiltration and intravenous diuretic treatment groups.
  
  
  CONCLUSIONS
  There are several limitations to our review, including publication bias and selection bias. Our review included only a few studies involving relatively few participants.
  
  
  CONCLUSIONS
  The available evidence suggests that early ultrafiltration is safe and effective for patients with hypervolemic acute heart failure. It allows greater fluid removal and weight loss by 48 h than do intravenous diuretics, with no significant increase in adverse effects.
authors.affiliation: Emergency Department, First Affiliated Hospital of Guangxi Medical University, Nanning, China, nnawen@163.com.
authors.forename: Hanchun
authors.initials: H
authors.lastname: Wen
authors.forename: Yougui
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jijin
authors.initials: J
authors.lastname: Zhu
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Lan
authors.forename: Han
authors.initials: H
authors.lastname: Yang
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014462:Ultrafiltration / Q000009:adverse effects / Q000379:methods*; D015431:Weight Loss
chemical_list: D004232:Diuretics